A Sore Throat, is it that simple?

Sore throat, is it that simple?Annually, million of patients consult medical providers for a "sore throat." At times, it can be benign and at other times it can be deadly or a medical emergency as in acute EPIGLOTTITIS. Bacterial pharyngitis is most commonly caused by group A ß-hemolytic Streptococcus pyogenes ("Strep" throat). This video presents a child with acute Erythema marginatum (rheumatic erythema) that resulted from streptococcal sensitization. This rash is also typical of Henoch-Schonlein Purpura which is a distinct syndrome mediated via our immune system against specific antigens, which includes upper respiratory tract infections, drugs, foods, insect bites and rarely immunizations.Allergic rhinitis often becomes complicated with sinopharyngitis and is readily apparent when a patient is properly examined. Sinopharyngitis is common in children and can be misdiagnosed as "an ear infection" because the pain may be referred to the ear. Sinopharyngitis is often misdiagnosed as "tonsillitis."Mononucleosis (CMV or EBV) can present as acute exudative tonsillopharyngitis. If these patients are treated with an antibiotic, the pain often becomes more severe as a result of secondary candidiasis. Candidiasis (fungal) resolves with Nystatin suspension and surgery is not indicated. The reader should see my other video that addresses this topic.Viral pharyngitis can be caused by other viruses such as Coxsackievirus A, Herpes Simplex (HSV) Types 1 and 2. Acute HIV can present with "Flu" like syndrome that may include pharyngitis and aseptic meningitis. Pharyngitis can also be caused by Neisseria gonorrhoeae, Syphilis (Secondary), Yersinia enterocolitica, anaerobic bacteria (Vincent's angina), atypical bacteria and rarely Corynebacterium diphtheriae in poorly or non-immunized patients (Tetanus/Diphtheria).There are many other conditions that cause a "sore throat" that can be as benign as a canker sore or as life threatening as Pemphigus vulgaris.In third world countries and even in the United States in patients that have not been properly vaccinated, may present with diphtheria pharyngitis, which can be deadly. One mother tried to sue her pediatrician (circa 1990's) because her child died of diphtheria pharyngitis. The mother had refused, on religious grounds, that her child be vaccinated against diphtheria.Patients with anxiety often present with what I call Autonomic Pharyngitis or Globus Hystericus. One man kept returning to see me because of his "sore throat." The conflict he had was that his wife had discovered that his girlfriend was pregnant. In another case, a 15-year-old girl, Cherry, kept seeing various providers for pharyngitis. When I saw Cherry, she denied any stressors. Eventually she had her tonsils removed, but her symptoms did not abate. Cherry was not doing well in school, was often truant, and her family was highly dysfunctional. A few months after her tonsillectomy, Cherry became pregnant and later a teen mother.George Washington, our first President, died from acute Epiglottitis. At age 67, he had contracted hoarseness and a sore throat. According to the principles of his day, he was subjected to multiple bleedings. The bleedings hastened his end. A tracheotomy could have saved him.In modern times, retropharyngitis, parapharyngitis, tonsillar abscesses and acute Epiglottitis can be life threatening. Many doctors have been sued because of failure to diagnose Epiglottitis.Since medical school, I developed the idea that I would one day see all the rare conditions mentioned in textbooks, and I have for the most part. To think otherwise, a clinician may fail to diagnose a life threatening condition.Docendo discimus (Latin): "We learn by teaching."This information is not intended for patients to self-diagnose. A properly trained medical provider must be consulted.Luis Lomeli MD

Channel: People & Blogs
Uploaded: May 18, 2007 at 10:45 pm
Author: LuisLomeliMD

Length: 03:12
Rating: N/A
Views: 380677

Tags: Conjunctivitis  Epiglottitis  Fever  Food  Hand  Lomeli  Luis  Mouth  Pharyngitis  Rheumatic  Strep  Tonsillectomy  Tonsils  Viral  

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